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YELM US Associates

Authorization Specialist - Authorizations

Clinical Support & Patient AdministrationUpdated on Nov 10
Full-timeBrooklyn, NY, USA

About the Job

Requirements

  • At least 1 year of experience working in an authorizations-related role in a home care agency.
  • Proficiency with HHA eXchange.
  • Proficiency with Excel.
  • Strong organizational, critical-thinking, and problem-solving skills, with attention to detail.
  • Ability to take initiative and follow up appropriately to complete tasks thoroughly and accurately.
  • Effective communication and interpersonal skills to build rapport with clients, caregivers, and healthcare professionals.
  • Ability to work collaboratively across departments.
  • High school diploma or equivalent.

Responsibilities

  • Process and track authorizations for home health services, ensuring timely submission to insurance providers.
  • Review patient records and treatment plans to ensure all required documentation is complete and accurate.
  • Communicate with insurance companies to secure necessary authorizations for services.
  • Communicate with insurance companies regarding revised authorizations, including fax time sheets, and other requested documents.
  • Manage and resolve denied or delayed authorization issues, including resubmissions or appeals.
  • Maintain detailed and accurate records of authorization activities.
  • Collaborate with clinicians, case managers, and other team members to ensure care plans align with authorization requirements.
  • Stay updated on changes in insurance policies, billing codes, and regulatory requirements related to home care.
  • Provide customer service to internal and external stakeholders through clear and efficient communication.
  • Review admissions, discharges, and temporary authorization reports weekly.
  • Monitor payer portals and follow up on requests from branches and intake.
  • Notify teams of authorization changes, including terminations, holds, hospitalizations, and increases or decreases.
  • Verify eligibility on the first business day of each month and on the 15th for flagged potential issues, and contact insurers by email or phone regarding potential service terminations or continuations.
  • Monitor the HHAEX Board and accept or deny cases.
  • Monitor and review payer messages on the home screen, update HHAEX, and advise Placement of changes accordingly.
  • Run reports from HHAEX, including the Temporary Report, Authorizations Due by Date Report, and Authorizations Report.
  • Create profiles for new members in HHAEX.
  • Merge profiles so clinical documents are kept in one place.
  • Monitor mail for authorization documents sent by contract providers.

About the Company

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